Care Home: Napier Lodge

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What the care home does well The residents in this home are well cared for. Staff meet residents to assess their care and support needs before deciding if the home can meet their needs effectively. This is a no smoking home. Prospective residents are informed of this when they enquire about the home. Residents have a plan of care that is followed by staff. It is regularly checked to make sure that it still meets their needs. Residents health needs are met and residents get the services and care they need. We observed staff interacting with residents. Staff were carefully supporting people who needed help with personal care. One resident said, " I am very happy here and would not like to go anywhere else. Everything is fine." Another resident commented, "Staff care for us when we need it, when we can`t help ourselves. They are very good." Routines in the home are flexible and residents spoken to said that they can choose when they get up and go to bed and whether they want to join in activities. Meals are varied and plentiful. Special diets are provided as needed or requested. A relative said "Mum is very happy here". She agreed and added, "The food is lovely." Residents were complimentary about the staff and the owner of the home. Residents said there were enough staff to support them well. Relatives are welcomed into the home ensuring that residents relationships are maintained. Relatives and friends spoken to said that staff always welcome them when they visit. A relative said, "The staff are so good here, so caring". Residents feel they are listened to and any concerns acted upon. Any concerns are robustly investigated and dealt with appropriately and sensitively. Residents and relatives said that the home is clean and fresh smelling ensuring a pleasant environment for people to live in. Staff training is good. All care staff have completed National vocational qualifications (NVQ). NVQ`s are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. What has improved since the last inspection? Care plans are clearer and have more information about the resident`s likes and dislikes in them. Most areas of medication management are carried out safely and correctly. What the care home could do better: The owner needs to apply to the Commission if she want to increase numbers of residents and make changes to the building. Liquid medication, creams, drops and ointments need dating when first opened so it is easy to monitor them.All details about prospective member of staff`s previous employment needs recording so the owner knows where they have worked and what skills they have. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Napier Lodge 47 Napier Avenue Blackpool Lancashire FY4 1PA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Pauline Caulfield     Date: 0 8 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Napier Lodge 47 Napier Avenue Blackpool Lancashire FY4 1PA 01253403047 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Trudie Cooper care home 12 Number of places (if applicable): Under 65 Over 65 12 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 12 Date of last inspection Brief description of the care home Napier Lodge is registered to provide residential care for twelve residents over the age of sixty-five years. The home is situated within a residential area of South Shore and is close to shops, libraries and other local amenities. Bus and tram routes are situated close-by. Napier Lodge is a no smoking home. Accommodation within the home is situated on the ground and first floors. Communal areas consist of four lounges and a dining room located on the ground floor. A passenger lift facilitates access between the ground and first floor. Toilet facilities are located on both floors and a number of bedrooms have en-suite facilities. A variety of aids are provided around the home to meet the needs of the residents. There is an enclosed patio area at the rear of the home and a small garden at the front of the Care Homes for Older People Page 4 of 28 Brief description of the care home home where residents often sit in the warm weather. There is a Statement of Purpose/Service User Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are, and what the resident can expect if he or she decides to live at the home. Information received (8/9/09) showed that the fees for care at the home are from three hundred and twenty pounds to three hundred and sixty five pounds per week, with the home paying for toiletries, hairdressing (except perms) chiropody and newspapers for residents. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit undertaken as part of the inspection process which commenced at 9am for six hours. Before the visit the home completed an annual quality assurance assessment (AQAA). This is a document that provides CQC with written information and an assessment about the quality of the services the home provides. The registered person is asked to provide us with this information each year. The inspection involved case tracking three residents as a means of assessing the care provided in the home. Case tracking means the inspector looks closely at a small group of people living in the home. We talk to them about the home if they are willing to and Care Homes for Older People Page 6 of 28 are able to talk to us. If they cannot talk to us we watch how staff care for, talk to and involve them in activities. We look at any information about their care and support and look around the home, particularly at rooms the case tracked residents use. We also spend time talking to other people in the home. We also talked to some staff and looked at administrative records in the home. Comment cards were received from six residents and seven members of staff. We have put this report together from watching the care provided, from comments received from residents, relatives and staff and written information we saw before or during the inspection. Two residents were spoken to individually and we had a long conversation with several residents who were sitting in the communal areas. Conversation with residents was very much dependent on their ability or wishes to speak to the Inspector. The owner, care manager and three care staff were spoken to. The last key inspection on this service was completed on 9th July 2007 What the care home does well: What has improved since the last inspection? What they could do better: The owner needs to apply to the Commission if she want to increase numbers of residents and make changes to the building. Liquid medication, creams, drops and ointments need dating when first opened so it is easy to monitor them. Care Homes for Older People Page 8 of 28 All details about prospective member of staffs previous employment needs recording so the owner knows where they have worked and what skills they have. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their relatives and staff have the information needed to support residents effectively and meet their needs. Evidence: Three people living in the home were case tracked and their care records were examined. Prospective residents are visited, usually in their own homes prior to admission to make sure that the home can meet the residents care needs. An assessment of needs is carried out prior to admission by the owner or the care manager and the home has a copy of the care management assessment by health or social services, where the resident is funded by them. A small group of residents chatted with us about moving into Napier Lodge. They said that they had been visited at home or in hospital by staff before they moved into Napier Lodge and asked what care they needed. One person living in the home said, Care Homes for Older People Page 11 of 28 Evidence: They made me very welcome here from the start. Standard 6 is not applicable as the home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about residents care needs is accurate and up to date so that all involved know how they should support each person. Evidence: We case tracked three residents. Care plans were short and simple but showed the care residents needed and were getting. Care records had improved from the previous key inspection and were clearer and more informative. There were social histories and likes and dislikes in place for each resident as well as information on each residents care needs. These included a brief life history for each resident so that they have more information about where the person has lived, their family life, working life and previous leisure activities. They were clearly and regularly reviewed and updated. Health issues were noted clearly in the section of care records for any medical involvement as well as in the daily records. The daily records in place showed visits from health professionals and any clinical care given by them as well as visits from family, outings and activities and any other relevant information. Accident forms were Care Homes for Older People Page 13 of 28 Evidence: completed where appropriate and this information as well as that provided in the other records gave clear information on any incident/accident. One of the residents case tracked had been involved in a fall and detailed information was in place regarding this. All falls and accidents/incidents are audited to see if any lessons can be learned from them. Staff record a minimum of two entries each day on each residents care records, ensuring everyone has clear up to date information on all residents in their care. Although care plans are still quite brief they showed the care provided to each resident. We were able to follow progress through the records. Risks assessment checklists were in place for all residents case tracked so any risks were reduced and managed appropriately. These were quite brief and where risks are higher it would be useful to have more detail in place but all were clearly reviewed and updated monthly. I spoke to a resident and her relative, they said how satisfied they are with the home and how well care for the resident is. They were very positive about the home, the staff, the food, the activities and the cleanliness in the home. Medication administration was mainly satisfactory with generally good storage, administration and disposal in place. Medication administration records were signed correctly. Where the times between administering a particular medication were short, these had been checked with the residents General Practitioner, to check that it would not have a negative effect on the resident. There is now a clear recording system showing all disposal of medication. Liquid medication, creams and ointments were not dated when opening and should be. This allows easier monitoring of medication and ensures that medication with a short shelf life is not kept too long once opened. A small number of residents administer their own medication using the monitored dosage system. The care manager regularly checks that these are being taken correctly and safely and records are kept of the medication given Staff advise residents of the health risks involved in smoking and the risks of passive smoking whilst accepting that some residents may choose to smoke. However there is no smoking inside the home, anyone wishing to smoke would have to smoke outside. Residents needs are appropriately met and those spoken to and those who returned comment cards were satisfied with their care. Residents said they receive the care and support they need. One resident said, They are lovely here are always ready to help you. Residents said staff were helpful and caring. One resident said I am happy here Care Homes for Older People Page 14 of 28 Evidence: and looked after well. We observed staff interactions throughout the inspection. Staff were respectful and polite to service users chatting to them frequently and checking they were comfortable. People living in the home who completed comment cards said the home meets their needs and supports them when they need it. A relative said that staff were good and kind and looked after people properly. Another relative commented that she was so happy with the home adding, The care they give my mum is good. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Meals are nutritious, routines are flexible and there are a some social and leisure activities which make life pleasant and comfortable for people living in the home. Evidence: Routines in the home are quite flexible and residents spoken to said that they decide when they get up and go to bed and whether they want to join in activities. People living in the home said that there are usually some activities available including people coming into the home to provide handicraft sessions, armchair exercises and music. Staff also encourage residents to play games, with limited success, do jigsaws and enjoy pamper sessions. There are also some trips out to local cafes, meals out and shows. One resident said how much she had enjoyed going for a meal out the previous week. The hairdresser visits regularly with the home paying for all hairdressing except for perms. Leisure activities are an important part of life in the home as leisure and social activities enable residents to interact with each other and to spend time together and pass time in a pleasant manner. The owner has a dog that sometimes socialises with residents. There is also a bird in the home. Residents said they enjoy having pets in the home. Care Homes for Older People Page 16 of 28 Evidence: All current residents are White British or Irish and are nominally Christian or have no religious persuasion. The home would endeavour to meet the needs of people from any other religion. Staff will support residents to practice their religion, if they wish. Some residents receive visits from ministers and representatives of local churches and places of worship who visit the home to assist residents to meet their spiritual needs. Staff are encouraged to discuss appropriate ways of meeting residents diverse needs as well as dignity and privacy issues. They understand the importance of supporting residents to make their own decisions and make their own choices. Relatives and friends said through the comment cards that the home supports people to live the life they choose. Residents said that staff were good. A resident said, Staff are always pleasant and friendly. Friends and relatives of residents can visit at any time so that relationships are maintained and developed and they can sit in the communal areas of the home or the residents bedroom if they wish. People living at Napier Lodge and their relatives said that meals are usually very good with a good choice of food. Alternatives are offered if a resident does not like the food on the menu. Residents birthdays and other important events are celebrated, usually with a buffet party. Residents or relatives handle their financial affairs. The home does not get involved in this. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Any concerns are handled well and people living in the home feel that they are listened to. Evidence: According to the AQAA, discussion with the manager and from surveys it is clear that residents know how to make a complaint and the home has responded appropriately to any concerns or complaints received. Residents said that staff listen and act on what they say. All concerns or complaints are recorded in detail and rigorously followed up. One relative had expressed some concerns in the last twelve months. These were investigated and any necessary action taken. The owner said that the relative had expressed satisfaction with the home since then. One resident said, I know what to do if I am not happy with something just tell the owner or staff and they will deal with it. Relatives spoken to felt they could easily talk to the owner or care manager if they had any concerns but were happy with the home. Staff have received safeguarding adults training on induction and on National Vocational training (NVQ) and have a good understanding of the action to be taken if they are alerted to a safeguarding issue. Staff said they could talk to the owners if they had any concerns about care and know they would deal with it. Care Homes for Older People Page 18 of 28 Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment in the home is comfortable, clean and pleasant to live in. Evidence: We toured the home and found it comfortable,clean and tidy. The home was very clean and fresh smelling. Residents spoken to said the home was always clean and tidy and there were never any nasty smells around the home. They said they liked Napier Lodge because it was small which meant they all knew each other quite quickly and it felt more like their own home than some other homes. Residents are encouraged to personalise their bedrooms so that they have familiar things around them and help them settle into the home. Aids and adaptations are in place to help residents get about more easily and to be as safe and as independent as they can be. There is a rolling programme of redecoration and all areas of the home are included in this. Recent improvements have included redecoration and new furniture and carpets in some bedrooms. When the weather is nice some residents enjoy sitting outside and chatting to people as they pass by. The home care service, which was situated in the Napier Lodge, reached by a separate Care Homes for Older People Page 20 of 28 Evidence: entrance, has moved and the area used is now vacant. The owner hopes to use this area to increase resident numbers slightly. Builders had already doing some work during the inspection. The owner needs to contact the Commission as soon as possible to apply to increase numbers and make the changes she plans as resident numbers cannot increase unless a variation of conditions is sought and accepted by the Commission. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most areas of recruitment and selection are good and sufficient staff numbers and training ensure the wellbeing and safety of residents. Evidence: A lot of the staff have worked in the home for several years and there is only a small staff turnover. This ensures that staff are familiar with residents and their care needs and residents know the people caring for them. One resident said, I am very happy here and would not like to go anywhere else. Another person living in the home said Staff make sure I have everything I need. Staff rotas showed sufficient staff on duty doing the inspection. Residents and staff felt that there were sufficient numbers of staff on duty to provide good care and support to residents. One resident said, I am very happy here and would not like to go anywhere else. Everything is fine. Another resident commented, Staff care for us when we need it, when we cant help ourselves. They are very good. We chatted to several staff during the inspection as well as through the staff surveys. Staff spoken to or who returned the surveys were satisfied with and enjoyed working in the home and felt well supported. One member of staff said, All staff do their best to fulfil the service users needs.. Care Homes for Older People Page 22 of 28 Evidence: The records of two members of staff were checked. One applicant did not have the name of the last employment on the application form. Only the duties involved in the job were in place. This information is needed as without it, it was difficult to check where the applicant last worked and which reference was from the last employer. Applicants did not always have the reason for leaving previous employment recorded on the application form and should do. All staff files had three written references in place and had PoVA checks and CRB checks. These are checks made to make sure prospective staff have not committed a criminal offence or been placed on a register of people unsuitable to work with vulnerable adults. There was health information in place. New staff had received a short induction, followed by quickly registering on National Vocational Qualification (NVQ) training so that they were aware of the care and support they needed to provide and how they should do this. All care staff have completed National vocational qualifications (NVQ). This is excellent and well above the requirement that fifty percent of staff complete this training. NVQs are national awards in care that enable staff to gain up to date skills and knowledge about current care practice. All care staff in the home who have not completed NVQ training are working towards National vocational qualifications (NVQ). Staff spoken to or who completed comment cards said they received regular training including moving and handling, medication and other mandatory training. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed and residents, relatives and staff feel they are listened to. Evidence: Napier Lodge is managed on a day to day basis by the registered owner, Mrs Trudie Cooper. She works in the home daily supporting the care manager and staff. They are aware of residents care and support needs and lead staff well. Mrs Cooper updates her skills and knowledge so that she is familiar with any developments in care practice. Staff said they felt well supported by the owner and felt that she was fair and willing to listen. Systems are in place for quality assurance. The home has recently met the standards for ISO 2000 which is a national quality assurance award. The award is valid until November 2010 when the home will have the opportunity to be reassessed. There are Care Homes for Older People Page 24 of 28 Evidence: regular staff meetings and issues discussed affect and improve care practice in the home. This gives the owner the opportunity to impart any information staff or residents need and to discuss any issues, concerns or ideas about the home. The owner carries out an internal audit yearly to monitor the quality of care in the home and whether they are meeting relevant regulations. Formal supervision is carried out regularly with records kept. Staff supervision allows the member of staff and manager or other nominated person to meet regularly and look at the member of staffs care practice and the care practice in the home, and any improvements that can be made. They also look at future plans in the home, training and the individuals career developments. Staff said that they had regular supervision. There are regular health and safety checks to ensure residents staff and visitors are kept safe. Any accidents or incidents are recorded and checks carried out to see if any lessons can be learned and risks reduced. There is a detailed homes risk assessment covering activities and areas of the home and a fire risk assessment. The fire service visited recently and advised some changes to the fire risk assessment. These have now been carried out. Staff are kept up to date with fire safety by regular fire training. The home does not hold any money for residents. Where the resident is unable to deal with finances and there is no family or power of attorney to deal with finances, the home encourages the resident to seek the advise of a solicitor. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 The owner must apply to the 24/11/2009 commission to change the conditions of registration if she wants to make changes to resident numbers. As resident numbers cannot increase without the commission agreeing a change of conditions of registration Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Liquid medication, creams, drops and ointments need dating when first opened. This allows easier monitoring of medication and ensure that medication with a short shelf life is not kept too long once opened. All employment history information should be in place for prospective staff so that the owner knows where the prospective person has worked and their previous skills and experience. 2 26 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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